title: Encephalitis due to Mycobacterium tuberculosis in France.
abstract: OBJECTIVE
  Two hundred and fifty-three patients were included in a study on the etiology of encephalitis, carried out in France in 2007. Tuberculosis was the second most frequently identified cause, after HSV and with the same number of cases as VZV. The authors report the specific features of patients presenting with tuberculosis encephalitis (TE).
  
  
  METHODS
  TE patients were defined as patients presenting with encephalitis, with positive culture or PCR for Mycobacterium tuberculosis, or the association of clinical, biological, imaging, and epidemiological evidence (possible cases). Clinical, microbiological, and brain imaging data was analyzed and compared to that of other included patients.
  
  
  RESULTS
  Twenty cases of TE were identified. The M/F sex-ratio was 1.5, the mean age 53 years. Four (20%) patients had a history of tuberculosis before the encephalitis. The median delay between the onset of general and neurological symptoms was significantly longer for tuberculosis cases than for others (10 days vs. 2; P<10(-10)). The median CSF protein level was significantly higher for tuberculosis cases (2.1 g/L vs. 0.8 g/L, P=0.002). CT scan and MRI were normal on admission for eight patients out of 17. Fourteen isolated strains of M. tuberculosis were susceptible to first-line anti-tuberculosis drugs and one was rifampicin-resistant. Six (33%) patients died during hospitalization and two were lost to follow-up. Ten out of 12 (78.6%) had persisting neurological symptoms on discharge.
  
  
  CONCLUSIONS
  Despite non-multiresistant MT strains, the case fatality rate among TE patients was high in our series. Early brain imaging is poor contributive for the diagnosis of TE.
authors.affiliation: Infectious diseases department, CHU and university 1, 38043 Grenoble cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Honnorat
authors.forename: T
authors.initials: T
authors.lastname: De Broucker
authors.forename: A
authors.initials: A
authors.lastname: Mailles
authors.forename: J P
authors.initials: JP
authors.lastname: Stahl
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D001921:Brain / Q000473:pathology; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D004359:Drug Therapy, Combination; D004660:Encephalitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism / Q000382:microbiology; D018792:Encephalitis, Viral / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D005947:Glucose / Q000134:cerebrospinal fluid; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D016896:Treatment Outcome; D020306:Tuberculosis, Central Nervous System / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D001786:Blood Glucose; D002556:Cerebrospinal Fluid Proteins; D005947:Glucose
keywords: Encephalitis; Encéphalite; Tuberculose; Tuberculosis